SEMS vs cSEMS in duodenal and small bowel obstruction: High risk of migration in the covered stent group

Table 1 Patients' characteristics n (%)

Characteristics	SEMS	cSEMS
Stents	16 (50)	16 (50)
Male gender	7 (44)	10 (63)
Age (yr), mean ± SD (range)	70 ± 11 (50-85)	71 ± 11 (50-84)
Localization
Jejunum, n	3	0
Duodenum, n	13	16
Disease
Pancreatic carcinoma, n	6	7
Cholangiocellular carcinoma, n	3	2
Gallbladder carcinoma, n	1	2
Gastric cancer, n	3	2
Colorectal cancer, n	2	0
Breast cancer metastasis, n	1	0
Stenosis due to duodenal ulcer perforation, n	0	3
Balloon dilatation of the stent	3 (19)	2 (13)
Concomitant biliary drainage	9 (56)	8 (50)

SEMS: Self-expanding metal stent; cSEMS: Covered SEMS.

Table 2 Complications n (%)

Complications	SEMS	cSEMS	P value
Duration of procedure (min), median (range)	60 (40-121)	60 (31-160)	0.867
Migration	0 (0)	9 (56)	0.002
Time until migration (d), mean ± SD (range)	-	30 ± 52 (1-161)	NA
Tumor overgrowth	3 (19)	2 (13)	0.725
Tumor ingrowth, n	0	0	NA
Time until tumor overgrowth (d), mean ± SD (range)	143 ± 95 (39-224)	96 ± 105 (22-170)	0.572
Overall survival (d), median, range	40 (3-275)	75 (11-426)	0.431

NA: Not available; SEMS: Self-expanding metal stent; cSEMS: Covered SEMS.

Table 3 Complication rates in small bowel self-expanding metal stents placement in retrospective analyses

Study	Patients, stents	Site of tumor obstruction	Tumor overgrowth	Migration	Bleeding	Perforation
Costamagna et al[1]	202, 212	Endoscopic duodenal stenting	12.4%	1.5%	3.0%	0.5%
van Hooft et al[2]	50, 57	Endoscopic stenting for gastric outlet obstruction	21.0%	4.0%	0.0%	0.0%
Jeong et al[4]	25, 28	Gastrojejunostomy, esophagojejunostomy, cSEMS	17.0%	4.0%	0.0%	1.0%
Chandrasegaram et al[7]	26, 31	Endoscopic stenting vs operative gastrojejunostomy	12.0%	0.0%	0.0%	0.0%
Jang et al[17]	583, 603	Peripyloric region, nonperipyloric region, duodenum alone anastomosis (Billroth I, Billroth II), jejunum	3.8%	NM	NM	< 1.0%
Kim et al[25]	50, 50	Endoscopic stenting for malignant gastroduodenal obstructions	18.0%	10.0%	0.0%	0.0%
Wong et al[26]	6, 6	Surgical vs endoscopic palliation	NM	NM	NM	NM
Mosler et al[27]	36, 52	Endoscopic stenting of nonesophageal upper gastrointestinal stenosis	11.0%	14.0%	0.0%	6.0%
Kim et al[28]	213, 236	Malignant gastroduodenal obstruction	7.0%	4.0%	1.0%	0.0%
Bang et al[29]	134, 132	Endoscopic treatment for malignant antropyloric and duodenal	cSEMS 5.7%SEMS 19.0%	cSEMS 26.4% SEMS 6.3%	2.2%	< 1.0%
Keränen et al[30]	104, 130	Endoscopic treatment for malignant gastric outlet obstruction	18.0%	0.0%	0.0%	1.9%
Ahn et al[31]	47, 52	Malignant gastroduodenal obstruction, uncovered SEMS	11.0%	2.0%	0.0%	4.0%
Canena et al[32]	74, 80	Endoscopic stenting for gastric outlet obstruction	9.5%	0.0%	1.4%	0.0%
Cha et al[33]	85, 85	Endoscopic stenting for gastroduodenal obstruction	29.0%	4.0%	4.0%	4.0%
Own data	20, 32	Small bowel/duodenum	cSEMS 13.0%SEMS 19.0%	cSEMS 56.0%SEMS 0.0%	0.0%	0.0%

SEMS: Self-expanding metal stent; cSEMS: Covered SEMS; NM: Not mentioned.